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Temporary inferior vena cava filters in major trauma
Filtros temporales de vena cava inferior en traumatismo grave
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Fracture of thyroid cartilage with a 4<span class="elsevierStyleHsp" style=""></span>mm opening (arrow) and subcutaneous emphysema (asterisk). (B) Case #3: nondisplaced fracture of the thyroid cartilage with solution of continuity (arrow) and subcutaneous emphysema (asterisk). (C) Case #4: sagittal fracture of the thyroid cartilage with solution of continuity (arrow) and cervical emphysema (asterisk). (D) Case #6: hematoma and edema with occlusion of the airway (arrow).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Viejo-Moreno, C. García-Fuentes, C. Mudarra-Reche, L.J. Terceros-Almanza, M. Chico-Fernández" "autores" => array:5 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Viejo-Moreno" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "García-Fuentes" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Mudarra-Reche" ] 3 => array:2 [ "nombre" => "L.J." "apellidos" => "Terceros-Almanza" ] 4 => array:2 [ "nombre" => "M." 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Chico Fernández, C. Mudarra Reche" "autores" => array:2 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Chico Fernández" ] 1 => array:2 [ "nombre" => "C." 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Ballesteros, J.A. Llompart-Pou, J.J. Egea-Guerrero" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M.Á." "apellidos" => "Ballesteros" "email" => array:1 [ 0 => "gelesballesteros@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J.A." "apellidos" => "Llompart-Pou" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J.J." "apellidos" => "Egea-Guerrero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Filtros temporales de vena cava inferior en traumatismo grave" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1843 "Ancho" => 2500 "Tamanyo" => 304454 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Proposal of prophylaxis for venous thromboembolic disease in patients with severe trauma. F(x), fracture; GCS, glasgow coma scale; IVC, inferior vena cava; LEs, lower extremities; TBI, traumatic brain injury; VTD, venous thromboembolic disease.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Venous thromboembolic disease (VTD) includes both the development of deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) and is one of the most significant complications of severe traumatic disease. The incidence rate of PTE is between 1% and 6% yet the presence of asymptomatic PTE is documented in up to 24% of the cases on the computed tomography scans performed during the first 7 days of disease progression.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The clinical guidelines for the management of trauma patients recommend prophylaxis with low molecular weight heparin and compression measures.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2,3</span></a> However, the coexistence of potentially fatal bleeding risk and the impossibility to apply physical measures of compression (due to the presence of long bone fracture in extremities) limit the options of prophylaxis. The use of prophylactic filters for the inferior vena cava (IVC) is suggested here as an alternative therapeutic option for the prevention of VTD even though to this day its indications, removal, and utility are issues still under discussion.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Indications for temporary inferior vena cava filters</span><p id="par0015" class="elsevierStylePara elsevierViewall">IVC filters have been used in the clinical practice since the 1970s and to this day several tests support the use of therapeutic filters for the management of severe traumatic disease yet do not support its prophylactic indication and there are no widely accepted patterns on this regard either.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A review of the indications for IVC filter placement suggests that these devices can be considered in trauma patients with high risk of developing VTD who are not eligible to receive anticoagulation therapy.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> The ideal candidates to receive these filters would be patients with serious traumatic brain injuries (TBI), spinal cord injuries with para- and tetraplegy, solid organ lesions, or complex pelvic fractures accompanied by long bone fractures that make prophylaxis with the corresponding compression measures absolutely impossible. However, the guidelines established by the American College of Chest Physicians in its last two iterations or the 4th edition of the European Guidelines for the Management of Traumatic Coagulopathy do not recommend the use of these filters for routine prophylactic purposes.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2,4,5</span></a> Here the lack of solid and conclusive evidence and the existence of contradictory guidelines from different scientific societies has brought variability to the prophylactic insertion of IVC filters in the trauma setting. This means that among same-level hospitals<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6,7</span></a> the use of IVC filters is not regulated, which has led to completely different insertion rates being reported somewhere between 0.6 and 9.6%.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">8,9</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Effectiveness of temporary inferior vena cava filters</span><p id="par0025" class="elsevierStylePara elsevierViewall">There is this idea that the prophylactic use of IVC filters is good enough to prevent VTD, yet several studies published have documented the development of DVT even with these devices already implanted.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">10,11</span></a> There are three (3) possible causes for this. In the first place, it may be due to the development of thrombi in pulmonary circulation or DVT in upper extremities, territories where the filter does no act upon. On the other hand, it may be showing the lateralization-related ineffectiveness of the device. Also, most devices are implanted within the first week following a severe trauma when the risk of bleeding is at its peak. Yet there is a prothrombotic phase when drug prophylaxis should be considered (7–10 days after filter insertion).<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The medical literature provides heterogeneous results when it comes to the effectiveness of these filters. Several publications including a recent meta-analysis conducted back in 2014 confirmed that the prophylactic insertion of IVC filters was associated with a lower incidence of PTEs and massive PTEs in trauma patients, but without an effect on the overall mortality.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">7,8,12</span></a> Also, cost-effectiveness analyses show low benefits, indicative that the selection of patients needs to be flawless.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> We believe that these studies should be interpreted with caution since, in many of them, mortality data were obtained from trauma registries with the corresponding limitations. Also, in the context of severe traumatic disease, several variables may impact mortality as confounding factors.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Complications associated with inferior vena cava filters</span><p id="par0035" class="elsevierStylePara elsevierViewall">IVC filters have complications, among which we may find vena cava perforations,<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> the displacement-migration of the device (2.2%),<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> and the thrombosis/occlusion of the filter (7.8%).<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> On the other hand, we should remember that although these filters are temporary, they are not always removed due to the lack of follow-up.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9,15</span></a> This perpetuates the situation of foreign body with the corresponding comorbidities since these filters do not reduce the risk of VTD to zero. The longer the filter remains in the body, the more thrombotic processes we may encounter with the corresponding complications during the extraction process.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">11,15</span></a> High scores in the Injury Severity Score, long bone fractures, and delays when initiating drug prophylaxis have been reported as independent factors associated with the development of PTE after the insertion of a prophylactic device.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> For all these reason, the presence of these filters inside the body should be minimal and drug prophylaxis should be initiated once the risk of hemorrhage is gone (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). For now it is hard to tell what the best moment is to remove the device, but there should be a follow-up on these filters, and their indication should be reconsidered once there is confirmation that VTD (drug or mechanical) prophylaxis is possible. The new generation of filters and the results recently published on this regard confirm that it is safe to remove them in much longer periods of time (up to 120 days).<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusions</span><p id="par0040" class="elsevierStylePara elsevierViewall">The IVC filter may play an important role in the prevention of VTD in severe trauma patients, yet the scarce evidence available on its indications and effectiveness added to the possible complications that may arise have prevented its widespread use. Trauma patients with contraindications to receive anticoagulation due to risk of bleeding and who are not eligible for mechanical prophylaxis should be a possible indication. Its implementation and follow-up should take place in selected centers in order to minimize associated secondary damages.</p><p id="par0045" class="elsevierStylePara elsevierViewall">We believe there is this pressing needs to identify the best clinical practice for the management of VTD in the setting of trauma patients. This study would give us the evidence we need to establish management guidelines and reduce variability in clinical practice.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declared no conflicts of interest whatsoever.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Indications for temporary inferior vena cava filters" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Effectiveness of temporary inferior vena cava filters" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Complications associated with inferior vena cava filters" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusions" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-05-28" "fechaAceptado" => "2018-09-06" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ballesteros MÁ, Llompart-Pou JA, Egea-Guerrero JJ. Filtros temporales de vena cava inferior en traumatismo grave. Med Intensiva. 2019;43:500–502.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1843 "Ancho" => 2500 "Tamanyo" => 304454 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Proposal of prophylaxis for venous thromboembolic disease in patients with severe trauma. F(x), fracture; GCS, glasgow coma scale; IVC, inferior vena cava; LEs, lower extremities; TBI, traumatic brain injury; VTD, venous thromboembolic disease.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence of asymptomatic pulmonary embolism in moderately to severely injured trauma patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.J. Schultz" 1 => "K.H. Brasel" 2 => "L. Washington" 3 => "L.R. Goodman" 4 => "R.R. Quickel" 5 => "R.J. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 6 | 12 |
| 2024 October | 55 | 51 | 106 |
| 2024 September | 53 | 17 | 70 |
| 2024 August | 56 | 41 | 97 |
| 2024 July | 28 | 20 | 48 |
| 2024 June | 45 | 50 | 95 |
| 2024 May | 30 | 28 | 58 |
| 2024 April | 42 | 37 | 79 |
| 2024 March | 39 | 25 | 64 |
| 2024 February | 30 | 38 | 68 |
| 2024 January | 29 | 31 | 60 |
| 2023 December | 29 | 30 | 59 |
| 2023 November | 41 | 28 | 69 |
| 2023 October | 23 | 27 | 50 |
| 2023 September | 29 | 30 | 59 |
| 2023 August | 23 | 18 | 41 |
| 2023 July | 28 | 24 | 52 |
| 2023 June | 23 | 18 | 41 |
| 2023 May | 43 | 30 | 73 |
| 2023 April | 31 | 14 | 45 |
| 2023 March | 60 | 28 | 88 |
| 2023 February | 59 | 24 | 83 |
| 2023 January | 25 | 11 | 36 |
| 2022 December | 63 | 23 | 86 |
| 2022 November | 59 | 32 | 91 |
| 2022 October | 52 | 23 | 75 |
| 2022 September | 26 | 29 | 55 |
| 2022 August | 41 | 33 | 74 |
| 2022 July | 27 | 24 | 51 |
| 2022 June | 23 | 20 | 43 |
| 2022 May | 26 | 30 | 56 |
| 2022 April | 32 | 36 | 68 |
| 2022 March | 30 | 40 | 70 |
| 2022 February | 25 | 24 | 49 |
| 2022 January | 24 | 24 | 48 |
| 2021 December | 45 | 37 | 82 |
| 2021 November | 37 | 27 | 64 |
| 2021 October | 124 | 63 | 187 |
| 2021 September | 30 | 20 | 50 |
| 2021 August | 33 | 32 | 65 |
| 2021 July | 22 | 22 | 44 |
| 2021 June | 23 | 10 | 33 |
| 2021 May | 44 | 48 | 92 |
| 2021 April | 86 | 107 | 193 |
| 2021 March | 64 | 29 | 93 |
| 2021 February | 48 | 33 | 81 |
| 2021 January | 38 | 20 | 58 |
| 2020 December | 38 | 14 | 52 |
| 2020 November | 30 | 13 | 43 |
| 2020 October | 10 | 10 | 20 |
| 2020 July | 10 | 6 | 16 |
| 2020 June | 22 | 8 | 30 |
| 2020 May | 28 | 4 | 32 |
| 2020 April | 16 | 8 | 24 |
| 2020 March | 12 | 10 | 22 |
| 2020 February | 3 | 1 | 4 |
| 2020 January | 1 | 0 | 1 |
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